1. Prognostic accuracy of qSOFA at triage in patients with suspected infection in a Brazilian emergency department.
- Author
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Ward A Maia I, Oliveira J E Silva L, Herpich H, Diogo L, Batista Santana JC, Pedrollo D, Castro Alvarez Perez M, and Nicolaidis R
- Subjects
- Aged, Anti-Bacterial Agents administration & dosage, Brazil epidemiology, Female, Humans, Infections drug therapy, Male, Middle Aged, Predictive Value of Tests, Prognosis, Retrospective Studies, Sensitivity and Specificity, Triage, Emergency Service, Hospital, Hospital Mortality, Infections mortality, Organ Dysfunction Scores
- Abstract
Objective: To evaluate the prognostic accuracy of qSOFA for predicting in-hospital mortality among patients with suspected infection presenting to the ED of a public tertiary hospital in Brazil., Methods: We performed a retrospective cohort study of consecutive adult patients (age ≥ 18 years) with suspected infection who presented to an academic tertiary ED in Porto Alegre (Southern Brazil) during an 18-month period. The qSOFA was calculated by using information collected at triage and patients were followed throughout hospitalization for the primary outcome of in-hospital mortality. Sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratios with corresponding 95% CIs were calculated for the qSOFA and qSOFA65., Results: A total of 7523 ED visits of patients with suspected infection in which an intravenous antibiotic was administered within 24 h were included, which resulted in 908 in-hospital deaths (12.1%). There were 690 (9.2%) patients whose triage qSOFA was ≥2 points. When such cutoff was used, the sensitivity for in-hospital death was 24.6% (95% CI 21.8 to 27.4%) and the specificity was 92.9% (95% CI 92.3% to 93.5%). The sensitivity increased to 67.4% (95% CI 64.2% to 70.3%) when a cutoff of ≥1 was tested, but the specificity decreased to 55.3% (95% CI 54.1% to 56.5%). Using a cutoff of ≥2, the qSOFA65 had a sensitivity of 51.0% (95% CI 47.7% to 54.3%) and a specificity of 75.7% (95% CI 74.6% to 76.7%)., Conclusions: The qSOFA score yielded very low sensitivity in predicting in-hospital mortality. Emergency physicians or ED triage nurses in low-to-middle income countries should not be using qSOFA or qSOFA65 as "rule-out" screening tools in the initial evaluation of patients with suspected infection., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2021
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